Fusarium Keratitis
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Diagnosis Synopsis
Fungal keratitis due to Fusarium species was reported in clusters of patients in Asia in early 2006. Soon thereafter, new cases were reported to the CDC by an ophthalmologist in New Jersey. Subsequent epidemiologic investigation by the CDC has resulted in increasing reports from multiple states during the spring of 2006. The initial investigation suggests that the eye fungus is related to contact lens use, and possibly from exposure to ReNu® with MoistureLoc® contact lens solution (permanently removed from worldwide distribution on 5-15-2006) or its generic equivalent.

Fusarium keratitis is a serious corneal stromal infection of the filamentous, non-pigmented Fusarium species. Infection with Fusarium solani, one of the more than 20 known species of Fusarium, is usually the most virulent Fusarium infection. If untreated, Fusarium keratitis can result in permanent corneal scarring and injury. The number of cases of fungal keratitis, including cases of Fusarium keratitis, has been rising during the past few decades.

Prior use of immunosuppressive agents, trauma, and recent ophthalmologic surgery are known risk factors for fungal keratitis. Contact lens use was an infrequent risk factor until the recent case reports. Prior to the 2006 reports, most cases of Fusarium keratitis were seen in the southeast US or in warmer climates. In the northeast, most cases of fungal keratitis were due to Aspergillus species.

Symptoms of Fusarium keratitis include eye pain, foreign body sensation, redness, tearing, discharge, or light sensitivity.

Look For
Fungal keratitis, in general, causes single or multiple corneal infiltrates with gray-white feathery edges and may have associated satellite lesions. There may be underlying corneal edema and/or an anterior chamber reaction. Advanced cases may demonstrate a hypopyon, a layering of white blood cells in the inferior anterior chamber angle.

Medical Disclaimer:
The information contained in this Web page is intended to be an adjunct to traditional medical information sources. It is not intended to be a substitute for professional medical judgment.

Author:
Christopher J. Rapuano, MD
Co-Director and Attending Surgeon, Cornea Service Co-Director, Refractive Surgery Department, Wills Eye Hospital
Professor, Jefferson Medical College of Thomas Jefferson University Philadelphia, PA

References:
Wills Eye Hospital, Kunimoto DY, Kanitkar KD, Makar M, Friedberg MA, eds. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.